Covered California has given residents a New Year’s gift by extending the deadline to apply for new health insurance with an effective date of January 1, 2014. Californians will now have until 6:00 pm on Saturday December 28th to enroll in the new ACA health plans. The caveat is that the enrollment must be completed online and possibly only by Certified Insurance Agents.
December 23rd website melt-down
The final day of the first extended deadline to apply on December 23rd turned into colossal melt down of the Covered California CalHEERS website. With the exception of the morning hours, the afternoon and evening up until midnight (I know because I was trying to input applications for clients) was met with system errors, stalled screens, time out errors and simply no response from the Covered California website.
Cover Up California?
The bitter irony was that the Executive Director Peter Lee of Covered California had told Sharokina Shams of Sacramento’s Channel 3 News TV station that the website was only experiencing a little slowness. He said pages were loading in about eight seconds. Mr. Lee was either seriously out of touch with how the website works and was functioning or he was deploying creative marketing spin, better known as “Cover Up California”.
December 31 plan closures
A significant amount of the bottle neck at the enrollment website was created by Covered California. The California Health Benefits Exchange Board insisted not only on creating a December 31 cancellation date for all plans issued by carriers participating in Covered California, they also refused to allow those plans an extension until March 31 of 2014. Consequently, there was a crush of people and families that were trying to enroll in health insurance on December 23rd.
Covered California mea culpa
The “new” deadline is an acknowledgment that Covered California created an environment that led to thousands of families not being able to enroll on Monday the 23rd because the system was unnecessarily swamp with people whose plans were being cancelled. While the correspondence from Covered California uses the euphemism of agents helping consumers cross the finish line of enrollment, we are just helping them get back in-line after being kicked off-line.
Certified agents allowed to keep enrolling Californians
The announcement to agents that they can continue to enroll Californians is a little vague and raises more questions than it answers. What is clear is that neither mailed in paper nor fax applications will be considered for January 1 effective dates with the new deadline. Only applications entered by Certified Insurance Agents directly into the system are eligible. The extended deadline is probably to help accommodate that thousands of paper applications that agents are being asked to enter after they sent them into Covered California months ago. Covered California insists that the application must have been started prior to December 23rd.
Can health plans respond?
Unclear is if Certified Enrollment Counselors or Covered California call center staff will also be keying in applications for January 1 effective date. I completed several applications Christmas Eve morning that should now be eligible for the January enrollment. The downside will be the additional pressure put on the health plans and insurance companies to create new member accounts, generate invoices and get them mailed to new plan members. The deadline for making payment for January 1 effectuation is still January 6th.
Another chance to get in line…online
If you missed completing your application online December 23rd because of the Covered California melt down you now have another opportunity to enroll. But instead of calling Covered California or faxing over your application you’ll have to find a Certified Insurance Agent to enter you application into the CalHEERS program online for you. Insurance agents never charge clients for their services. They are always paid by the insurance company or health plan by either a one-time payment, fixed monthly monthly or a commission percentage.
Pick me! Pick me!
Now where can you find a Certified Agent…maybe the answer is right in front of you 🙂
Covered California email to agents
Application Finalization for January 1st Effective Date “Getting Over the Finish Line”
Consumers’ interest in Covered California has been remarkable! Through the efforts of County Eligibility Workers, Certified Insurance Agents, Service Center Representatives, Certified Enrollment Counselors and Plan-Based Enrollers, Covered California supported over 400,000 individuals to get ready for the final step with their enrollment process and to pay their initial premium to start their coverage. This occurred within the first 3 months of Open Enrollment.
Covered California is committed to helping the enrollment of consumers who need affordable, high quality health insurance. The following describes our approach in getting consumers enrolled with a January 1, 2014 effective date of coverage. These approaches are being implemented to help consumers who made good faith attempts to complete their enrollment process on time.
Agents who have started an application beforeDecember 23rd, but did not complete the enrollment process until after December 23rd.
• Covered California’s Certified Insurance Agents will continue to assist consumers to “get over the finish line” to help them receive an January 1st effective date of coverage.
• In order to keep the January 1st effective date of coverage, all Certified Insurance Agents can continue to key in applications when consumers contact them to complete the application and plan enrollment process. Applications keyed into CalHEERS by 6:00 p.m. on December 28th may receive the January 1st effective date.
• A job aid will be posted on the Covered California, agent tab on Thursday, December 26th that will give you details on how to perform the manual work around process to keep the January 1st effective date under these circumstances.
• Any completed application submitted after December 28th after 6:00 p.m. will continue to be accepted. However, the consumer will receive a February 1st effective date.
Certified Insurance Agents who were unable to key in applications into the CalHEERS system by December 23rd will receive an extension to enter in the applications.
• Covered California will keep the January 1st effective date for applications that are submitted into CalHEERS from Certified Insurance Agents. In order to keep the January 1st effective date, the application must be completed with a plan enrollment by December 28th (by 6:00 p.m.).
• Any completed on-line application submitted after December 28th after 6:00 p.m. will continue to be accepted. However, the consumer will receive a February 1st effective date.
Mailed or faxed paper applications received by December 24th.
• Any completed faxed or mailed applications received by Covered California with plan enrollment on December 24th will continue to receive the January 1st effective date.
• Any completed mailed or faxed applications received after December 24th will continue to be accepted. However, the consumer will receive a February 1st effective date.
Reminders to consumers to pay their premiums.
Covered California will encourage consumers to proactively reach out to their selected health plans to pay their initial premium. Both e-mails and notices will be sent to consumers whose enrollment information has already been submitted to the health plans. We will remind consumers that they must pay their premiums by the January 6th payment due date. – Covered California
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Lack of electronic communication
I have yet to hear of any consumer who has received an email from Covered California. That is one of the major flaws of the systems; lack of electronic communication. I have started taking screen shots of the client’s eligibility and health plan confirmation and sending it to the family because Covered California had no system to communicate with the new enrolled member.
PCIP health insurance extended
The federally subsidized Pre-Existing Condition Insurance Plan has been extended through January to help members of the PCIP enroll in new health plans. Text of the Health and Human Services press release announcing the extension and other items to help consumers.
- Title
- Taking Steps to Smooth Consumers’ Transition into Health Coverage Through the Marketplace
- For Immediate Release
- Thursday, December 12,2013
- Contact
- press@cms.hhs.gov
Taking Steps to Smooth Consumers’ Transition into Health Coverage Through the Marketplace
Today, the Administration is announcing the steps we are taking to immediately make it easier for individuals to purchase health plans through the Marketplace and access the doctors and prescription medications they may need during the transition to new health insurance. We will continue to look for additional steps we can take to make this process easier for consumers.
Giving Consumers More Flexibility on Deadlines To Sign Up and Pay For Coverage
Extending the Enrollment Deadline to December 23
- Today, we are formally extending the deadline for signing up through the Marketplaces for coverage beginning January 1 from December 15 to December 23 (this also applies to the Federally-Facilitated SHOP).
- We will consider moving this deadline to a later date should exceptional circumstances pose barriers to consumers enrolling on or before December 23.
Reminding Consumers of the Special Enrollment Period for Individuals Who Have Trouble Signing Up Due to an Error Made By the Marketplace
- If an individual tries to sign up by December 23rd but experiences an issue with the Marketplace, they qualify for a special enrollment period and gain coverage as soon as possible.
Giving Those With Some of the Most Severe Health Conditions Additional Time on Their Current Health Plan
- We are allowing enrollees to stay in the federal Pre-existing Condition Insurance Plan (PCIP) program through January to ease their transition into Marketplace plans. This step will help take pressure off of this vulnerable group’s enrollment in coverage through the Marketplace by December 23rd.
Encouraging Insurers to Give Consumers Even More Flexibility to Sign Up for Coverage Effective January 1
- We are encouraging insurers to allow people who sign up after December 23 to get coverage on January 1.
- This includes allowing issuers to offer retroactive coverage for people who sign up after January 1. For example, if a person signs up and pays on January 5, they can have coverage with a start date of January 1 (which qualifies them for the advance premium tax credit).
Giving Consumers More Time to Make Their First Premium Payments
- We are requiring insurers to provide coverage beginning on January 1 if a person pays by December 31 (previously, issuers could have set an earlier deadline).
- We are also encouraging insurers to allow individuals who signed up by December 23 but didn’t pay until sometime in January to get coverage starting on January 1. We are also encouraging insurers to allow people who pay part but not all of their premium to have their coverage start on time.
Helping Consumers Access Their Doctor and Prescription Drugs During This Transition
Strongly Urging Insurers to Cover the Additional Doctors and Prescription Drugs Consumers Need During January
- We are strongly encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes.
- We are strongly encouraging issuers to treat out-of-network providers as in-network if the provider was listed in their plan’s provider directory as of the date of an enrollee’s enrollment.
- And we are strongly encouraging insurers to refill prescriptions covered under previous plans during January.
Making Sure Consumers Have Accurate Information So They Can Pick the Health Plan That Works Best for Them
- Provider directories and formularies (lists of prescription drugs covered by a plan) are now available in anonymous shopping and can be reviewed prior to choosing a plan.
- We are clarifying that issuers should make sure provider directories for Marketplace plans are accurate and up to date, so that consumers have all the information they need to choose the plan that’s right for them.
Ensuring That Consumers Know Their Rights
- We are working to make sure consumers know their existing right to appeal an insurers’ decision not to cover a particular consumer or medication, the ability to get an off-formulary drug through an exceptions process, and the right to emergency care outside of networks at in-network rates.
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